Johan Sundström1, Jakob Hedberg2, Marcus Thuresson2, Pernilla Aarskog2, Kasper Munk Johannesen2, Jonas Oldgren2. 1. From Department of Medical Sciences (J.S., J.O.), Uppsala Clinical Research Center (J.S., J.O.), and Department of Surgical Sciences (J.H), Uppsala University, Sweden; Statisticon AB, Uppsala, Sweden (M.T.); AstraZeneca Nordic Baltic, Södertälje, Sweden (P.A.); and Linköping University, Sweden (K.M.J.). Johan.Sundstrom@medsci.uu.se. 2. From Department of Medical Sciences (J.S., J.O.), Uppsala Clinical Research Center (J.S., J.O.), and Department of Surgical Sciences (J.H), Uppsala University, Sweden; Statisticon AB, Uppsala, Sweden (M.T.); AstraZeneca Nordic Baltic, Södertälje, Sweden (P.A.); and Linköping University, Sweden (K.M.J.).
Abstract
BACKGROUND: There are increasing concerns about risks associated with aspirin discontinuation in the absence of major surgery or bleeding. We investigated whether long-term low-dose aspirin discontinuation and treatment gaps increase the risk of cardiovascular events. METHODS: We performed a cohort study of 601 527 users of low-dose aspirin for primary or secondary prevention in the Swedish prescription register between 2005 and 2009 who were >40 years of age, were free from previous cancer, and had ≥80% adherence during the first observed year of treatment. Cardiovascular events were identified with the Swedish inpatient and cause-of-death registers. The first 3 months after a major bleeding or surgical procedure were excluded from the time at risk. RESULTS: During a median of 3.0 years of follow-up, 62 690 cardiovascular events occurred. Patients who discontinued aspirin had a higher rate of cardiovascular events than those who continued (multivariable-adjusted hazard ratio, 1.37; 95% confidence interval, 1.34-1.41), corresponding to an additional cardiovascular event observed per year in 1 of every 74 patients who discontinue aspirin. The risk increased shortly after discontinuation and did not appear to diminish over time. CONCLUSIONS: In long-term users, discontinuation of low-dose aspirin in the absence of major surgery or bleeding was associated with a >30% increased risk of cardiovascular events. Adherence to low-dose aspirin treatment in the absence of major surgery or bleeding is likely an important treatment goal.
BACKGROUND: There are increasing concerns about risks associated with aspirin discontinuation in the absence of major surgery or bleeding. We investigated whether long-term low-dose aspirin discontinuation and treatment gaps increase the risk of cardiovascular events. METHODS: We performed a cohort study of 601 527 users of low-dose aspirin for primary or secondary prevention in the Swedish prescription register between 2005 and 2009 who were >40 years of age, were free from previous cancer, and had ≥80% adherence during the first observed year of treatment. Cardiovascular events were identified with the Swedish inpatient and cause-of-death registers. The first 3 months after a major bleeding or surgical procedure were excluded from the time at risk. RESULTS: During a median of 3.0 years of follow-up, 62 690 cardiovascular events occurred. Patients who discontinued aspirin had a higher rate of cardiovascular events than those who continued (multivariable-adjusted hazard ratio, 1.37; 95% confidence interval, 1.34-1.41), corresponding to an additional cardiovascular event observed per year in 1 of every 74 patients who discontinue aspirin. The risk increased shortly after discontinuation and did not appear to diminish over time. CONCLUSIONS: In long-term users, discontinuation of low-dose aspirin in the absence of major surgery or bleeding was associated with a >30% increased risk of cardiovascular events. Adherence to low-dose aspirin treatment in the absence of major surgery or bleeding is likely an important treatment goal.
Authors: Tracey G Simon; Ann-Sofi Duberg; Soo Aleman; Raymond T Chung; Andrew T Chan; Jonas F Ludvigsson Journal: N Engl J Med Date: 2020-03-12 Impact factor: 91.245
Authors: Kathryn T Hall; Thorsten Kessler; Julie E Buring; Dani Passow; Howard D Sesso; Robert Y L Zee; Paul M Ridker; Daniel I Chasman; Heribert Schunkert Journal: Eur Heart J Date: 2019-11-01 Impact factor: 29.983